Upper cervical mobilization. The physical therapist uses the bottom hand to stabilize the segment while the top hand moves the segment gently. The therapist may hold this position as a stretch or perform gentle oscillatory( to and fro) movements.
Neck flexor strength and endurance exercise. A towel is place under the neck. The patient is instructed to gently nod his head by bringing his chin towards his throat. This position may be held for 10 to 20 seconds, and repeated based on the ability to perform correctly.
Another component of physical therapy treatment Another component of physical therapy treatment includes deep neck flexor muscle strength and endurance training. Strengthening the deep neck flexor muscles will assist in the maintenance of upright posture; therefore, decreasing muscle tension and stress in the head and neck. Initially, training begins in the supine position( Figure 5), and eventually is progressed to other positions such as sitting or standing.
The physical therapy interventions described above are commonly implemented with individuals who suffer from CTTH. This is not an exhaustive list, however. The physical therapist may elect to utilize additional interventions that are patient specific to ensure an individualized treatment plan is executed. Since physical therapy has proven to be effective for individuals who suffer from CTTH, it should be considered as a part of the comprehensive treatment plan. It is essential that the physical therapist works together with other members of the individual’ s healthcare team to provide optimum care. HW
Recommended Reading
1. Castien R et al. The working mechanism of manual therapy in participants with chronic tension type headache. JOSTP 2013; 43:693-699.
2. Fernandez de las Penas C. Clinical reasoning for manual therapy management of tension type and cervicogenic headache. JMMT 2014; 22: 45-51.
3. Jull G et al. Clinical assessment of the deep cervical flexor muscles: The Craniocervical Flexion Test. J Manipul Physiol Ther 2008: 31:525-533.
4. Winkel D. Differential diagnosis of the spine. Nonoperative Orthopeadic Medicine and Manual Therapy. Austin, TX: PRO-ED, Inc; 1996.
30 HeadWise ® | Volume 6, Issue 1 • 2016